Irritable Bowel Syndrome Treatments

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IRRITABLE BOWEL SYNDROME TREATMENTS
Generic Brand Strength Form Usual Dose
5-HT3 RECEPTOR ANTAGONIST
alosetron HCl Lotronex Rx 0.5mg, 1mg tabs Adults: 0.5mg twice daily; may increase to 1mg twice daily after 4wks if needed. If constipation occurs, discontinue until constipation resolves, then restart at 0.5mg once daily. Discontinue if constipation recurs or inadequate symptom control after 4wks of treatment at 1mg twice daily.
Children: Not recommended.
5-HT4 RECEPTOR AGONIST
tegaserod Zelnorm Rx 6mg tabs Adults: IBS-C (women <65yrs only): 6mg twice daily ≥30mins before a meal. Discontinue after 4–6wks if inadequate control.
Children: Not established.
ANTICHOLINERGICS
dicyclomine HCl — Rx 10mg/5mL syrup Adults: Initially 20mg 4 times daily; may increase to 40mg 4 times daily after 1wk if tolerated. Discontinue if not effective within 2wks or daily doses ≥80mg are not tolerated. Inj: Give by IM route only. 10−20mg four times daily for max 1−2 days when oral therapy is not feasible.
Children: <6mos: Contraindicated. ≥6mos: Consult manufacturer.
10mg caps
20mg tabs
Bentyl Injection 10mg/mL inj
BARBITURATE + ANTICHOLINERGICS
phenobarbital/
hyoscyamine 
sulfate/
atropine 
sulfate/
scopolamine 
HBr		 Donnatal Elixir Rx 16.2mg/
0.1037mg/
0.0194mg/
0.0065mg per 5mL		 liq1,4 Adults: 5−10mL 3−4 times daily.
Children: <10lb (4.5kg): Not recommended. 10lb (4.5kg): Initially 0.5mL every 4hrs or 0.75mL every 6hrs. 20lb (9.1kg):,1mL every 4hrs or 1.5mL every 6hrs. 30lb (13.6kg): 1.5mL every 4hrs or 2mL every 6hrs. 50lb (22.7kg): 2.5mL every 4hrs or 3.75mL every 6hrs 75lb (34kg): 3.75mL every 4hrs or 5mL every 6hrs. 100lb (45.4kg): 5mL every 4hrs or 7.5mL every 6hrs.
Donnatal Tablets Rx 16.2mg/ 0.1037mg/ 0.0194mg/ 0.0065mg tabs Adults: 1−2 tabs 3−4 times daily
Children: Not recommended.
BENZODIAZEPINE + ANTICHOLINERGIC
chlordiazep–
oxide HCl/
clidinium bromide		 Librax CIV 5mg/
 2.5mg		 caps Adults: Individualize. Usually 1−2 caps 3−4 times daily before meals and at bedtime. Elderly or debilitated: max 2 caps daily initially, then may increase gradually.
Children: Not established.
GI MOTILITY ENHANCER
(CHLORIDE CHANNEL ACTIVATOR)
lubiprostone Amitiza Rx 8mcg, 24mcg caps ≥18yrs: Take with food and water. IBS-C (women only): 8mcg twice daily. Severe hepatic impairment (Child-Pugh Class C): initially 8mcg once daily; if tolerated and inadequate response, may escalate to full dose; monitor.
<18yrs: Not established.
GUANLYATE CYCLASE-C AGONIST
linaclotide Linzess Rx 72mcg, 145mcg, 290mcg caps Adults: Take on empty stomach, at least 30mins before first meal of the day. IBS-C: 290mcg once daily.
Children: <6yrs: Contraindicated. 6−17yrs: Avoid.
plecanatide Trulance Rx 3mg tabs Adults: IBS-C: 3mg once daily.
Children: <6yrs: Contraindicated. 6–17yrs: Avoid.
MU-OPIOID RECEPTOR AGONIST
eluxadoline Viberzi CIV 75mg, 100mg tabs Adults: Take with food. IBS-D: 100mg twice daily. Mild or moderate hepatic impairment, moderate or severe renal impairment, ESRD (not on dialysis), concomitant OATP1B1 inhibitors, intolerance to 100mg: 75mg twice daily.
Children: Not established.
RIFAMYCIN
rifaximin Xifaxan Rx 550mg tabs ≥18yrs: IBS-D: 550mg three times daily for 14 days. Recurrent episodes: can retreat up to two times with the same dose.
<18yrs: Not established.
NOTES

Key: IBS-C = irritable bowel syndrome with constipation; IBS-D = irritable bowel syndrome with diarrhea; ODT = orally disintegrating tablets; SL = sublingual

1 contains alcohol; 2 dye-free, peppermint flavor; 3 orange flavor; 4 grape flavor

Not an inclusive list of medications and/or official indications. Please see drug monographs at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 12/2020)

This article originally appeared on MPR

Topics:

Colorectal Disorders Gastroenterology Gastrohepatic Disorders Irritable Bowel Syndrome